Monitoring of neoadjuvant chemotherapy using multiparametric, 23Na sodium MR, and multimodality (PET/CT/MRI) imaging in locally advanced breast cancer
Monitoring of neoadjuvant chemotherapy using multiparametric, 23Na sodium MR, and multimodality (PET/CT/MRI) imaging in locally advanced breast cancer
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DOI：
10.1007/s10549-011-1442-1
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发表时间：
2011-07-01
影响因子：
3.8
通讯作者：
Stearns, Vered
中科院分区：
文献类型：
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作者：
Jacobs, Michael A.;Ouwerkerk, Ronald;Stearns, Vered
我们使用先进的磁共振成像（MRI）和正电子发射断层扫描/计算机断层扫描（PET/CT）进行前瞻性研究，以确定接受术前全身治疗（PST）的局部晚期乳腺癌患者治疗反应的放射生物标志物。选择接受 PST 的 II 期或 III 期乳腺癌患者，并在整个治疗过程中在基线和第一个 PST 周期（第 7-8 天）后进行正电子发射断层扫描 (PET)、磁共振成像 (MRI) 和乳腺活检。注射 2-脱氧-2-[18F]-氟-d-葡萄糖（(18)FDG，0.22 mCi/kg）后采集 PET/CT，并通过标准化摄取值评估 (SUV) 进行量化。在 1.5 T 下采集诊断性乳腺 MRI 和钠 (Na-23)。对总组织钠浓度 (TSC)、实体瘤反应标准 (RECIST) 和体积进行量化。治疗反应由手术时的病理评估确定。对活检标本进行增殖指数（Ki-67）的免疫组织化学值。接受 PST 的 19 名符合资格的女性（43 +/- A 11 岁）中的 6 名接受了 (18)FDG-PET/CT 和 MRI 放射学成像，并接受了至少两个治疗周期。 5 名患者出现病理部分缓解 (pPR)，1 名患者出现病理无缓解 (pNR)。有反应者的 TSC 下降 21%，无反应者则增加 (P = 0.03)。与无反应者 (22%；P = 0.03) 相比，反应者 (38%) 的 SUV 下降幅度更大。第 1 周期后 MRI 体积减少了 42%（有反应者）和 35%（无反应者；P = 0.11）。在第一个周期中，应答者的增殖指数 Ki-67 下降（中位数 = 47%，范围 = 29-20%），但非应答者的增殖指数 Ki-67 增加 (4%)。在有反应者中观察到 TSC、SUV 和 Ki-67 显着降低，而在无反应者中观察到 TSC 和 Ki-67 显着增加。我们的结果证明了使用多模态质子、Na-23 MRI 和 PET/CT 指标作为放射生物标志物来监测可手术乳腺癌患者对 PST 反应的可行性。
We prospectively investigated using advanced magnetic resonance imaging (MRI) and positron emission tomography/computed tomography (PET/CT) to identify radiological biomarkers for treatment response in patients receiving preoperative systemic therapy (PST) for locally advanced breast cancer. Patients with a stage II or III breast cancer receiving PST were selected and underwent positron emission tomography (PET), magnetic resonance imaging (MRI), and breast biopsies at baseline and after the first cycle of PST (days 7-8) during the full course of treatment. PET/CT was acquired after injection of 2-deoxy-2-[18F]-fluoro-d-glucose ((18)FDG, 0.22 mCi/kg) and quantified with standardized uptake value assessment (SUV). Diagnostic breast MRI and sodium (Na-23) was acquired at 1.5 T. Total tissue sodium concentration (TSC), response criteria in solid tumors (RECIST), and volumes were quantified. Treatment response was determined by pathological assessment at surgery. Immunohistochemistry values of the proliferative index (Ki-67) were performed on biopsy specimens. Six of nineteen eligible women (43 +/- A 11 years) who received PST underwent radiological imaging of (18)FDG-PET/CT and MRI for at least two cycles of treatment. Five patients had a pathological partial response (pPR) and one had pathological non-response (pNR). TSC decreased 21% in responders with increases in the non-responder (P = 0.03). Greater reduction in SUV was observed in responders (38%) compared to the non-responder (22%; P = 0.03). MRI volumes decreased after cycle 1 by 42% (responders) and 35% (non-responder; P = 0.11). Proliferation index Ki-67 declined in responders in the first cycle (median = 47%, range = 29-20%), but increased (4%) in the non-responder. Significant decreases in TSC, SUV, and Ki-67 were observed in responders with increases in TSC and Ki-67 in non-responders. Our results demonstrate the feasibility of using multi-modality proton, Na-23 MRI, and PET/CT metrics as radiological biomarkers for monitoring response to PST in patients with operable breast cancer.